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Should Your Child See a Doctor?

Abdominal Pain

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Definition

  • Pain or discomfort located between the bottom of the rib cage and the groin crease
  • The older child complains of a stomachache
  • The younger child should at least point to or hold the abdomen

Causes 

  • Indigestion: Indigestion or overeating causes many mild stomachaches
  • Gastroenteritis: A viral infection of the intestines causes stomach cramps as well as vomiting and/or diarrhea
  • Food Poisoning: Severe vomiting and/or diarrhea lasting less than 12 hours is often due to bacterial overgrowth in unrefrigerated foods
  • Constipation: The need to pass stool causes lower abdominal cramps
  • Strep: A strep throat causes up to 10% of acute abdominal pain
  • Serious Causes: These include appendicitis, kidney infections and intussusception. Suspect appendicitis if pain low on the right side, won't hop or jump and prefers to lie still.
  • Stress: The most common cause of recurrent stomachaches is stress (commonly called the "worried stomach"). Over 10% of children have them. These children tend to be sensitive, serious, conscientious, even model children. This can make them more vulnerable to the normal stresses of life, such as changing schools, moving or family disagreements. The pain occurs in the pit of the stomach or near the belly button. The pain is mild but real.

When to Call Your Doctor for Abdominal Pain

Call 911 If…

 
  • Your child is not moving or too weak to stand
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • You suspect poisoning with a plant, medicine, or chemical
  • Unable to walk or walks bent over holding the abdomen
  • Pain mainly low on the right side
  • Pain or swelling in the scrotum or testicle (Male)
  • Could be pregnant (Female)
  • Severe pain anywhere
  • Constant pain (or crying) present over 2 hours
  • Blood in the stool or vomiting blood
  • Vomiting bile (bright yellow or green)
  • Recent injury to the abdomen
  • Age under 2 years
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Mild pain that comes and goes (cramps) lasts over 24 hours
  • Fever is present
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Abdominal pains are a recurrent chronic problem
 

Parent Care at Home If

  • Mild abdominal pain and you don't think your child needs to be seen
 

Home Care Advice for Mild Abdominal Pain

  1. Reassurance:
    • A mild stomachache can be caused by something as simple as gas pains or overeating.
    • Sometimes a stomachache signals the onset of a vomiting or diarrhea illness from a virus (gastroenteritis).
    • Watching your child for 2 hours will usually tell you the cause.
     
  2. Rest: Encourage your child to lie down and rest until feeling better.
  3. Clear Fluids: Offer clear fluids only (e.g., water, flat soft drinks or half-strength Gatorade). For mild pain, offer a regular diet.
  4. Prepare for Vomiting: Keep a vomiting pan handy. Younger children often refer to nausea as a "stomachache".
  5. Pass a stool: Encourage sitting on the toilet and trying to pass a stool. This may relieve pain if it is due to constipation or impending diarrhea. (Note: For constipation, sitting in warm water may relax the anus and help release a stool)
  6. Avoid Medicines: Any drug (especially ibuprofen) could irritate the stomach lining and make the pain worse. Do not give any pain medicines or laxatives for stomach cramps. For fever over 102° F (39° C), acetaminophen (Tylenol) can be given.
  7. Expected Course: With harmless causes, the pain is usually better or resolved in 2 hours. With gastroenteritis (stomach flu), belly cramps may precede each bout of vomiting or diarrhea and last several days. With serious causes (such as appendicitis), the pain worsens and becomes constant.
  8. Call Your Doctor If:
    • Pain becomes severe
    • Constant pain present over 2 hours
    • Mild pain that comes and goes present over 24 hours
    • Your child becomes worse
     

Worried stomach: extra advice

  • Help your child talk about events that trigger the abdominal pain and how to cope with these triggers next time.
  • Help your child worry less about things he or she can't control.
  • Teach your child to use relaxation exercises (relaxing every muscle in the body) to treat the pain. Lie down in a quiet place; take deep-slow breaths; and think about something pleasant. Listening to CDs or audiotapes that teach relaxation might help.
  • Teach your child the importance of getting adequate sleep.
  • Make sure that your child doesn't miss any school because of stomachaches. Stressed children have a tendency to want to stay home when the going gets rough.
  • Caution: Your child should have a complete medical checkup before you conclude that recurrent stomachaches are due to worrying too much.

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1.  Anders J, Powell E. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Arch Pediatr Adolesc Med. 2005;159(6):532-535.
  2. Ashcraft KW. Acute abdominal pain. Pediatr Rev. 2000;21:363-367.
  3. Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med. 2007;14:124.
  4. Bundy DG, Byerley JS, Liles EA, et al. Does this child have appendicitis? JAMA. 2007;298(4):438-451.
  5. Goldman RD, Carter S, Stephens D, et al. Prospective validation of the pediatric appendicitis score. J Pediatr. 2008;153:278.
  6. Gremse DA and Sacks AI. Evaluation of dyspepsia. Pediatr Ann. 1997;26:251-259.
  7. Klein EJ, Paris CA. Appendicitis. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p.287-297.
  8. Kuppermann N, O’Dea T, Pinckney L, Hoecker C. Predictors of intussusception in young children. Arch Pediatr Adolesc Med. 2000;154:250-255.
  9. Mason JD. The evaluation of acute abdominal pain in children. Emerg Med Clin North Am. 1996;14:629-643.
  10. McCollough M, Sharieff G. Abdominal pain in children. Pediatr Clin North Am. 2006;53(1):107-120.
  11. Pena BM, Taylor GA, Lund DP. Appendicitis revisited: New insights into an age-old problem. Contemp Pediatr. 1999;16(9):122-131.
  12. Pollack E. Pediatric abdominal surgical emergencies. Pediatr Ann. 1996;25:448-457.
  13. Scholer SJ, et al. Clinical outcome of children with acute abdominal pain. Pediatrics. 1996;98:680-685.  

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/13/2010 6:02:53 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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